Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 Aban 2022
Introduction: The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed to investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS).
Methods: Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.
Results: A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)).
Conclusion: This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.
- Diagnostic Accuracy
- Point-of-Care Testing
- Diagnostic Imaging
How to Cite
Organization WH. Acute intussusception in infants and children: incidence, clinical representation and management: a global perspective. World Health Organization; 2002.
Justice FA, Auldist AW, Bines JE. Intussusception: trends in clinical presentation and management. Journal of gastroenterology and hepatology. 2006;21(5):842-6.
Waseem M, Rosenberg HK. Intussusception. Pediatric emergency care. 2008;24(11):793-800.
Arroyo AC, Zerzan J, Vazquez H, Dickman E, Likourezos A, Hossain R, et al. Diagnostic accuracy of point-of-care ultrasound for intussusception performed by pediatric emergency medicine physicians. The Journal of Emergency Medicine. 2021;60(5):626-32.
Bergmann KR, Arroyo AC, Tessaro MO, Nielson J, Whitcomb V, Madhok M, et al. Diagnostic accuracy of point-of-care ultrasound for intussusception: a multicenter, noninferiority study of paired diagnostic tests. Annals of Emergency Medicine. 2021;78(5):606-15.
Tonson la Tour A, Desjardins MP, Gravel J. Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department. Academic Emergency Medicine. 2021;28(8):866-72.
Lee J-Y, Kim JH, Choi SJ, Lee JS, Ryu J-M. Point-of-care ultrasound may be useful for detecting pediatric intussusception at an early stage. BMC pediatrics. 2020;20(1):1-6.
Chang Y-J, Hsia S-H, Chao H-C. Emergency medicine physicians performed ultrasound for pediatric intussusceptions. Biomed J. 2013;36(4):175-8.
Lam SH, Wise A, Yenter C. Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review. World Journal of Emergency Medicine. 2014;5(4):255.
Riera A, Hsiao AL, Langhan ML, Goodman TR, Chen L. Diagnosis of intussusception by physician novice sonographers in the emergency department. Annals of emergency medicine. 2012;60(3):264-8.
Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest. 2013;144(6):1868-75.
Zieleskiewicz L, Lopez A, Hraiech S, Baumstarck K, Pastene B, Di Bisceglie M, et al. Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. Critical Care. 2021;25(1):1-12.
Trigylidas T, Kelly J, Hegenbarth M, Kennedy C, Patel L, O'Rourke K. 395 pediatric emergency medicine-performed point-of-care ultrasound (POCUS) for the diagnosis of intussusception. Annals of Emergency Medicine. 2017;70(4):S155.
Li XZ, Wang H, Song J, Liu Y, Lin YQ, Sun ZX. Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta‐Analysis. Journal of Ultrasound in Medicine. 2021;40(6):1077-84.
Hernandez JA, Swischuk LE, Angel CA. Validity of plain films in intussusception. Emergency radiology. 2004;10(6):323-6.
Patsikas MN, Papazoglou LG, Paraskevas GK. Current Views in the Diagnosis and Treatment of Intestinal Intussusception. Top Companion Anim Med. 2019;37:100360.
Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic. Acad Radiol. 2017;24(5):521-9.
Rogers TN, Robb A. Intussusception in infants and young children. Surgery (Oxford). 2010;28(8):402-5.
Arnaud O, Weil D, Boscq M, Michel J, Robert M. Value of ultrasonics in the diagnosis of acute intestinal invagination in infants and children. Apropos of a series of 60 cases. Archives Francaises de Pediatrie. 1986;43(6):407-8.
Pracros J, Tourasse C, Morin de Finfe C, Basset T, Louis D, Carlioz P. Acute intestinal intussusception: ultrasonic diagnosis and air insufflation. Pediatrie. 1990;45(2):109-13.
Bhisitkul DM, Listernick R, Shkolnik A, Donaldson JS, Henricks BD, Feinstein KA, et al. Clinical application of ultrasonography in the diagnosis of intussusception. The Journal of pediatrics. 1992;121(2):182-6.
Verschelden P, Filiatrault D, Garel L, Grignon A, Perreault G, Boisvert J, et al. Intussusception in children: reliability of US in diagnosis--a prospective study. Radiology. 1992;184(3):741-4.
Wood S, Kim JS, Suh SJ, Paik TW, Choi SO. Childhood intussusception: US-guided hydrostatic reduction. Radiology. 1992;182(1):77-80.
Lim HK, Bae SH, Lee KH, Seo GS, Yoon GS. Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography. Radiology. 1994;191(3):781-5.
Shanbhogue RL, Hussain SM, Meradji M, Robben SG, Vernooij JE, Molenaar JC. Ultrasonography is accurate enough for the diagnosis of intussusception. Journal of pediatric surgery. 1994;29(2):324-8.
Barzilai M. Ultrasound in suspected intussusception. Harefuah. 1994;127(1-2):5-8, 64.
Wright J, Slater S. Suspected intussusception: is ultrasound a reliable diagnostic aid? Australian and New Zealand journal of surgery. 1996;66(10):686-7.
Sarihan H, Dinc H, Abes M, Cay A, Serce K. The role of sonography in diagnosis of intussusception. Early Human Development. 1997;49(3):251.
Stanley A, Logan H, Bate T, Nicholson A. Ultrasound in the diagnosis and exclusion of intussusception. Irish Medical Journal. 1997;90(2):64-5.
John SD. The value of ultrasound in children with suspected intussusception. Emergency Radiology. 1998;5(5):297-305.
Harrington L, Connolly B, Hu X, Wesson D, Babyn P, Schuh S. Ultrasonographic and clinical predictors of intussusception. The Journal of pediatrics. 1998;132(5):836-9.
Smoljanić Z, Zivić G, Krstić Z, Milanović D, Vukanić D, Lukac R. Intestinal intussusception in children. Ultrasonic diagnosis. Srpski Arhiv za Celokupno Lekarstvo. 2000;128(7-8):259-61.
Henrikson S, Blane CE, Koujok K, Strouse PJ, DiPietro MA, Goodsitt MM. The effect of screening sonography on the positive rate of enemas for intussusception. Pediatric radiology. 2003;33(3):190-3.
Eshed I, Gorenstein A, Serour F, Witzling M. Intussusception in children: can we rely on screening sonography performed by junior residents? Pediatric radiology. 2004;34(2):134-7.
Justice FA, de Campo M, Liem NT, Son TN, Ninh TP, Bines JE. Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam. Pediatric Radiology. 2007;37(2):195-9.
Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatric radiology. 2009;39(10):1075-9.
Muniz A. Ultrasound diagnosis of intussusception by emergency physicians. Acad Emerg Med. 2010;17(5):1-15.
Henderson AA, Anupindi SA, Servaes S, Markowitz RI, Aronson PL, McLoughlin RJ, et al. Comparison of 2-view abdominal radiographs with ultrasound in children with suspected intussusception. Pediatric Emergency Care. 2013;29(2):145-50.
Lin W-C, Lin C-H. Re-appraising the role of sonography in pediatric acute abdominal pain. Iranian Journal of Pediatrics. 2013;23(2):177.
Zerzan J, Arroyo A, Dickman E, Vazquez V. Diagnosing intussusception by bedside ultrasonography in the pediatric emergency department. Acad Emerg Med. 2012;19(Suppl 1):S151.
Jones T, Das I, Au-Yong K, Johnson K. An evaluation of the diagnostic accuracy of ultrasound in the diagnosis of paediatric intussusceptions. Clinical Radiology. 2012;67:S5.
Mwango G, Salim S, Wambugu M, Aywak A. Role of abdominal ultrasound imaging in evaluation of children with suspected upper gastrointestinal disease. East African Medical Journal. 2012;89(8):250-7.
Kim JH, Kang HG, Lim TH, Je SM, Choi HJ, Kang BS, et al. Ultrasonography of suspected ileocolic intussusceptions performed by emergency medicine residents. Journal of the Korean Society of Emergency Medicine. 2012;23(5):643-8.
Usang UE, Inah GB, Inyang AW, Ekabua AT. Intussusception in children: Comparison between ultrasound diagnosis and operation findings in a tropical developing country. African Journal of Paediatric Surgery. 2013;10(2):87.
Ja Lim K, Lee K, Yoon DY, Moon JH, Lee H, Kim M-J, et al. The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases. Acta Radiologica. 2015;56(2):228-33.
Al-Ani MM, Ghani SH. Evaluation of intussusception in children: Our experience in 47 cases. IRAQI JOURNAL OF MEDICAL SCIENCES. 2017;15(3).
VanHouwelingen LT, Seims AD, Ortega-Laureano L, Coleman JL, McCarville MB, Davidoff AM, et al. Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review. Pediatric Radiology. 2018;48(2):204-9.
- Abstract Viewed: 772 times
- pdf Downloaded: 665 times